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The Honolulu Advertiser
Posted on: Tuesday, October 10, 2006

Maui moves toward cardiac-care upgrade

By Christie Wilson
Advertiser Neighbor Island Editor

WAILUKU, Maui The state's conditional approval yesterday of a certificate of need for expanded cardiovascular services at Maui Memorial Medical Center means heart-attack patients will have a better chance of recovery and will no longer have to fly to O'ahu or the Mainland for treatment.

Getting prompt treatment for a heart attack can mean the difference between being able to play tennis two weeks later or spending the rest of your life in a wheelchair connected to an oxygen tank, said David Russell, a registered nurse and coordinator of Maui Memorial's cardiovascular services. For many Maui patients, it was the wheelchair, or worse, because comprehensive cardiac care has not been available at the 231-bed Wailuku hospital.

More than 200 patients required emergency transport to O'ahu for interventional cardiac treatment in 2004, waiting an average of four and a half hours for an air ambulance.

The certificate-of-need approval "is outstanding news because right now for acute heart attacks, just by geography there was a delay in treatment, and during that time heart muscle is dying," Russell said. "I've had many cases where patients have waited for hours with crushing heart pain, and we do the best we can in medically managing them. I could fill a book with the number of times I've been confronted by family who just don't understand why we can't fix them right this minute and are so dependent of an airplane that may take 24 hours to get here."

In the past, open-heart surgery services were not feasible at Maui Memorial because of the island's relatively small population. Since medical authorities have long recommended that surgical backup be available for cases needing cardiac intervention, the hospital has been limited to diagnostic procedures. All Maui doctors could do when faced with a patient suffering from an acute heart attack was administer a large dose of clot-busting medicine and hope that it reached the heart to dissolve the clot, while awaiting air ambulance transport to Honolulu.

Maui Memorial officials say the island's growing population, and recent medical advancements, now make an expanded cardiovascular intervention program possible. The newly approved program will allow doctors to respond to heart attacks by stent placement or balloon angioplasty procedures that expand the arteries or by catheterization to deliver a smaller, more concentrated dose of clot-busting medicine directly to the heart.

They also will be able to perform bypass, valve repair and other open-heart surgeries. Hospital officials said they expect to perform 194 such operations by the third year of expanded services.

Along with patients, Maui Memorial also stands to benefit from offering expanded cardiovascular services. In its certificate of need application, hospital officials said they expect a $3 million profit in the first year alone.

The state-subsidized Maui hospital is part of the Hawaii Health Systems Corp. that runs a dozen other Neighbor Island and O'ahu hospitals. Profits from the Maui hospital are used to offset losses at the smaller facilities.

Some had questioned whether the move to expand the cardiovascular program was designed to fend off potential competition from the proposed Malulani Health & Medical Center in Kihei, which last week was denied approval by the State Health Planning and Development Agency to build a hospital that would have provided the same services.

But Maui Memorial officials said the expansion is part of a broader strategy by Hawaii Health Systems Corp. to convert the Maui hospital into a referral center for Maui and the Big Island and ease some of the Neighbor Island patient load carried by O'ahu hospitals.

The expanded cardiovascular intervention program will not require construction costs because it will be housed in renovated space within the hospital, Maui Memorial officials said. However, $1.5 million will be spent on equipment and salaries.

As a condition of approval, the agency is requiring Maui Memorial to submit by March 2 a plan for creating "a collaborative organization with the cardiovascular physicians on Maui to ensure appropriate credentialing, staff training, clinical protocols and quality outcomes for the proposed services," including a plan for rapid transportation to the cardiac surgery operating room.

Reach Christie Wilson at cwilson@honoluluadvertiser.com.